Ethen Chiropractic & Wellness, SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ETHEN CHIROPRACTIC & WELLNESS, SC

Practice address

630 Vernon Ave
Suite F
Glencoe, IL 60022

Phone

(847) 835-4700

Fax

(847) 835-8408

NPI assigned

Oct 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Joseph John Ethen, DCNPI 1700845047

Title

President

Phone

(847) 835-4700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakefront Chiropractic Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

Ethen Chiropractic and Wellness3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Ethen Chiropractic and Wellness

  • Chiropractor
  • Glencoe, IL
  • NPI 1336535608
  NPD tax ID
• Lakefront Chiropractic

  • Chiropractor
  • Glencoe, IL
  • NPI 1972990737
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph John Ethen, D.C.

  • Chiropractor
  • Glencoe, IL
  • NPI 1700845047
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316649600000",
    "number": "1457530628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 VERNON AVE",
            "address_2": "SUITE F",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "60022",
            "telephone_number": "847-835-4700",
            "fax_number": "847-835-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 VERNON AVE",
            "address_2": "SUITE F",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "60022",
            "telephone_number": "847-835-4700",
            "fax_number": "847-835-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEN CHIROPRACTIC & WELLNESS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2011-09-22",
        "status": "A",
        "authorized_official_last_name": "ETHEN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-835-4700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "9358811",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakefront Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diverge Health, Inc.
• Anne Rousseau Douglas, M.S., LMFT
• Doyle Opticians of Glencoe Inc
• DRS Sripada MD SC
• Juliette Rachel Ellis, P.T.
• Ethen Chiropractic and Wellness
• Joseph John Ethen, D.C.
• Family Service of Glencoe
• Fore Fitness and Rehabilitation, Inc
• Jane Ann Forester, D.O.

• All providers in Glencoe, IL
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.